Posterior cricoid-graft mismatch in laryngotracheal reconstruction

Introduction/Objective: In laryngotracheal reconstruction (LTR) with sutureless posterior cricoid grafting (PCG), the inset graft's thickness may not precisely approximate the anterior-posterior depth of the divided posterior cricoid plate. This case series highlights this phenomenon and describes the clinical profiles and airway characteristics of children with similar subglottic stenosis grades undergoing LTR with PCG with varying degrees of graft-cricoid mismatch. Methods: This is a case series with retrospective chart review of children who underwent LTR with PCG by a single surgeon at a tertiary care urban children's hospital from 2008 to 2014. Results: Twenty-one patients with twenty-two operations were identified. Varying degrees of graft-cricoid mismatch were present. Of the 22 operations, 15 were classified as grade I (flush), 5 grade II (< 3 mm), and 2 grade III (> 3 mm). Median preoperative grade of stenosis was III in all groups. Mean one month granulation grade was 1.84, compared to 1.92 in grade I, 1.6 in grade II mismatch, 2 in grade III mismatch, and 1.7 in any mismatch (p = 0.65). Mean follow up was 24 months. Conclusion Graft-cricoid mismatch may occur at variable degrees during laryngotracheal reconstruction utilizing sutureless posterior cricoid grafting. Our preliminary data suggest several millimeters of graft-cricoid mismatch can be tolerated without significantly affecting postoperative granulation formation or adding to postoperative morbidity.